摘要
目的总结颅脑手术后颅内感染的临床诊治体会,探讨治疗术后颅内感染的有效方法。方法采用回顾性分析方法,选择广州中医药大学第一附属医院2007年1月～2015年3月收治的26例术后颅内感染患者,所有患者均采用综合治疗,如脑脊液细胞学检查、细菌培养,静脉及鞘内使用头孢曲松钠或其他敏感抗生素。观察患者脑脊液细菌培养情况、抗菌药物的选择情况、脑脊液引流及鞘内给药方法的选择情况、治愈例数及治愈时间。结果 14例脑脊液细菌培养结果阳性(53.8%),其中金黄色葡萄球菌4例,表皮葡萄球菌4例,产气肠杆菌2例,大肠埃希菌2例,铜绿假单胞菌2例。脑脊液细菌培养结果为金黄色葡萄球菌、表皮葡萄球菌、产气肠杆菌、大肠埃希菌的12例阴性患者均应用头孢曲松钠静脉注射和鞘内给药;脑脊液细菌培养为铜绿假单胞菌的患者使用头孢曲松钠效果较差,1例改用头孢哌酮钠他唑巴坦钠,1例改用美罗培南。15例患者选择腰大池置管持续引流,11例患者行腰椎穿刺、脑脊液置换。26例患者全部治愈,腰椎穿刺术患者与腰大池置管患者的治愈时间比较差异无统计学意义(P> 0.05)。结论基于病原微生物特性,采用综合疗法对术后颅内感染有良好的治疗效果。
Objective To summarize the experience of clinical diagnosis and treatment about the intracranial infection after craniocerebral operation, and to explore an effective method for the treatment of postoperative intracranial infection. Methods By retrospective analysis, 26 patients with intracranial infections after operation admitted to the First Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2007 to March 2015 were selected. All of the cases were treated with comprehensive treatment, such as cerebrospinal fluid cytology examination, bacterial culture, intravenous and intrathecal use of Ceftriaxone Sodium or other sensitive antibiotics. The conditions of cerebrospinal fluid bacterial culture, choice of antibacterial agents, choice of cerebrospinal fluid drainage and intrathecal administration, healing cases and healing time were observed. Results The results of cerebrospinal fluid bacterial culture in 14 cases were positive （53.8%）, among which, there were 4 cases of Staphylococcus aureus, 4 cases of Staphylococcus epidermidis, 2 cases of Enterobacter aeruginosa, 2 cases of Escherichia coli and 2 cases of Pseudomonas aeruginosa. All of 12 cases of patients with negative cerebrospinal fluid bacterial culture results of Staphylococcus aureus and Epidermis staphylococcus, Enterobacter aeruginosa, Escherichia coli and cerebrospinal fluid culture were taken intravenous Ceftriaxone Sodium and intrathecal drug delivery. The effect of Ceftriaxone Sodium on patients whose cerebrospinal fluid bacterial culture result was Pseudomonas aeruginosa was poor. Therefore, 1 case was converted to Cefoperazone Sodium and Tazobactam, and 1 case was converted to Meropenem. Fifteen patients selected continued lumbar cistern drainagee, 11 cases selected lumbar puncture, cerebrospinal fluid replacement. Twenty-six patients were all cured, the difference of the healing time between lumbar puncture patients and lumbar cistern drainagee patients was not statistically significant （P 〉 0.05）. Conclusion Based on the characteristics of pathogenic microorganisms, comprehensive therapy has a good effect on postoperative intracranial infection.
作者
袁淮涛
黄良文
任建伟
刘建民
YUAN Huaitao;HUANG Liangwen;REN Jianwei;LIU Jianmin(The First Clinical Medical School,Guangzhou University of Chinese Medicine,Guangdong Province,Guangzhou 510405,China;Craniocerebral Department,the First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangdong Province,Guangzhou 510405,China)
出处
《中国医药导报》
CAS
2018年第32期118-120,124,共4页
China Medical Herald
基金
广东省广州市科技计划项目(201607010365)
关键词
颅内感染
神经外科
综合治疗
病原微生物
Intraeranial infection
Neurosurgery
Comprehensive treatment
Pathogenic microorganism
作者简介
袁淮涛（1981-）．男．广州中医药大学第一临床医学院2015级中西医结合临床专业在读博士研究生；研究方向：中枢神经系统肿瘤、颅脑损伤、脑血管病和功能神经外科（三叉神经痛、面肌痉挛）等。;[通讯作者]刘建民（1974-）．男．博士．副主任医师；研究方向：中枢神经系统肿瘤及动脉瘤的治疗。
